2. Learning objectives:
To define malnutrition
to identify vulnerable group
To identify Types of malnutrition disorders
To detect the preventive measures of
malnutrition
3. Definition of malnutrition:
Malnutrition is poor nutrition due to an
insufficient, poorly balanced diet,
faulty digestion or poor utilization of
foods (This can result in the inability
to absorb foods).
4. At risk group of
malnutrition:
Infants, children, elderly….
(dependant on others)
رعيته عن مسئول كل و راع كلكم
Mentally disabled
People suffering from health
problems e.g. TB, cancer, HIV,
……………
5. MALNUTRITION
over
nutrion
• poverty, faulty habits, diseases
• increased demands
• congenital anomalies
• bad sanitary condition
1-Under
nutrition
• Sedentary life
• High energy foods and drinks
• Familial causes
• Hormonal, drug use
• Emotional
2-Over
nutrition
5
6. Causes of under nutrition
Poverty, big family size, lack of food as
in war or disasters.
Faulty diet habits.
Belief, traditions, and religions as to
prevent some types of food as in Hindus
who DO not eat meat.
Illiteracy and low nutritional
knowledge.
7. Cont. Causes of under
nutrition
Faulty weaning, insufficient pregnancy
spacing.
Increased demands as in adolescents and
lactating women.
Chronic diarrhea, anorexia, vomiting and
malabsorption syndrome.
Parasitic infection: taenia saginata, ascaris,
bilharziasis.
Infections, chronic diseases, burns, post-
operative.
8. Cont. Causes of under
nutrition
Congenital anomaly as cleft palate, hare
lip. Prematurity in infants.
Bad sanitary conditions.
Psychological and emotional problems.
Inadequate health services both in quantity
and quality can repel clients from seeking
health appraisal and medical care.
10. PREVENTION OF MALNUTRITION
Survey studies
Socioeconomic development
Health education
Food production
Food fortification
Special feeding programs
Increase health services
10
14. Group affected Nutritional problems
Children
Protein energy malnutrition, impaired growth, anemia,
rickets, scurvy, dental caries, vitamin A and iodine deficiency.
May be obesity
Adolescents
Delayed puberty, impaired growth, impaired mental
&psychological growth. Anemia, goiter, scurvy, vitamin B &A
deficiency. Obesity.
Pregnant &
lactating
mothers
Anemia, folic acid deficiency, osteomalacia, dental caries,
vitamin deficiency
Elderly
Dehydration, vitamin deficiency, osteoporosis, protein
deficiency.
Table showing main nutritional problems in
vulnerable groups
15. A- Macronutrient def
Protein deficiency: (protein energy
malnutrition PEM or PCM)
Clinical manifestations are:
underweight, impaired growth,
as Kwashiorkor and Marasmus.
16. Causes of PEM:
- Faulty weaning: sudden cessation of breast feeding
and replacement with starchy foods (potatoes, rice)
leading to Kwashiorkor. Deficient breast feeding and
replacement by non-nutrient fluids (karawia, sugar) or
diet deficient in proteins leading to marasmus.
- Same causes of under nutrition as poverty, infections,
fevers, diarrhea, parasites, prematurity, congenital
anomalies.
18. Prevention of PEM
Health education about breast feeding
& proper weaning.
Growth monitoring for early detection
of PEM.
Nutrition supplements & rehydration all
can serve to cure and prevent these
diseases.
20. 1- Iron deficiency anemia (IDA):
Decreased hemoglobin concentration than
standards. Mainly due to nutritional iron
deficiency due to decreased intake of animal
proteins, bad dietary habits, parasitic infections
and increased needs as in pregnant, lactating
women and adolescents.
Prevalence of anemia in Egypt is 30% on average.
21. Clinical symptoms & signs of iron deficiency
anemia:
1. Pale skin, loss of appetite and apathy.
2. Insufficient iron for the synthesis of red blood
cells causes fatigue.
3. Decreased attention, learning ability, work
performance and immune status.
4. Dry brittle nails which later become flat and
spoon shaped.
22. Diagnosis of IDA:
1- Clinical picture.
2- Haemic murmurs of the heart.
3- Blood picture:
Low haemoglobin < 11gm./dL.(different cut-
off(s) in different ages)
Decreased red cell count.
Small color index 0.5-0.7.
23. Prevention of IDA:
1. Adequate dietary intake; through raising
nutrition awareness by nutrition education
regarding good dietary sources for sources of
iron and factors affecting iron absorption.
2. Dietary supplementation of at risk group
infant, preschool, school, pregnant and lactating
women in dry milk and bread
3. Prevention and control of parasitic diseases
and pathological conditions associated with
blood loss.
24. 2- Rickets
Prevalence is 25% in developing countries. Due
to vitamin D deficiency (affecting children 6-24
months).
Predisposing factors:
25. Cont. Predisposing factors of Rickets
Poor supplementation during pregnancy
with calcium, vitamin D.
Insufficient exposure of child to sun,
wrapping in clothes.
Recurrent gastroenteritis, premature
infant, low birth weight infant.
26. 1. Skeletal manifestations:
Crainiotabes (softening of skull
bones, bossing of parietal and
frontal bones, delayed closure of
anterior fontanel and delayed
eruption of teeth.
Enlarged metaphyseal ends of
long bones (wrists and ankles).
Deformities of long bones and
pelvis in neglected cases.
Chest: rachitic beads of ribs
(rickety rosary), pigeon chest,
and Harrison’s sulcus.
27. 2)Other manifestations
of rickets:
Hypotonia,
Tetany and convulsions
due to impaired calcium
absorption.
Chest infections (due to
chest deformity and
suppression of immunity)
28. Prevention:
Health education of mothers for healthy nutrition.
Supplementation of pregnant, lactating mothers with cod
liver oil, vit D. Exposure of children to sun before 11am
or after 4 pm.
Breast feeding, weaning with cow milk.
Supplementation of powdered milk with vit. D.
Increases inter pregnancy spacing.
Early diagnosis of rickets by growth monitoring.
Specific measures: giving vitamin D supplementation in
powdered milk or as drug (oral drops 400 IU daily or IM
200,000 IU every 6 months under medical supervision).
29. 3- Osteomalacia
Disease of young women in child bearing period
due to repeated un spaced pregnancies, lactation
with deficient calcium intake with/without vitamin
D deficiency.
Prevention:
Birth control, increase space between pregnancies
increase calcium intake in diet or by calcium drug
intake for prophylaxis exposure to sun.
30. 4- Osteoporosis
An ageing process of bones. Occurs in old females,
postmenopausal, weight < 56kg, sedentary life. After
using corticosteroids, immunosuppressant, heparin
and anticonvulsants.
Prevention:
Should start early before menopause, increase
calcium and vitamin D intake.
31. 5- Vitamin A deficiency
Bitot spots in cornea
Causes: deficient Intake of food containing
vitamin A as egg yolk, liver, fish oil, carrot,
mango, apricot.
32. Signs & symptoms
Xerophthalmia, delayed growth, decrease in iron
utilization, follicular keratosis of the skin and
increased susceptibility to respiratory and urinary
tract infections (anti-infection vitamin).
Night blindness: impaired dark adaptation due to
lack of formation of visual purple in the eye. Often
referred to as nyctalopia or day sight.
Conjunctival xerosis due to due to affection of the
lacrimal gland
Bitot spots in the cornea
Corneal ulceration and keratomalacia
Blindness
34. Prevention :
1. Nutrition education :increase intake of
foods containing vitamin A
2. Vitamin A is given in M.C.H. services for
mothers after labor (200 000IU) and for
infants as drops at 9th month (100 000IU)
and another dose at 18th month (200
000IU) as prophylactic dose against
deficiency.
3. Fortification of foods with vitamin A as
margarines, vegetable oils and dried
skimmed milk.
35. 6- Iodine deficiency
IODINE def gives hypothyroidism & goiter. Still
birth & miscarriage.
Cretinism: mental retardation, stunted,
hypothyroidism, deaf mutism.
Occurs in groups living away from sea,
adolescents who are in need of more iodine.
Prevention: Intake of sea feeds, vegetables grown
on iodized soil. Fortification of table salt with
iodine.
36.
37. 7- Dental caries
Some risk factors as deficiency in calcium,
phosphorus, vitamin D and fluorine.
8- Folic acid anemia:
Common in alcoholics, vegetarians, elderly, oral
contraceptive pills, frequent pregnancy and lactation
neural tube defects of infants.
38. Folate (folic acid)
• Functions:
• Produces
DNA and
RNA, making
new body
cells
• Works with
vitamin B12
to form
hemoglobin
• Lowers risk
of neural tube
defects in
babies
• Food sources:
• Green, leafy
veggies
• Whole grains
• Meat
• Orange
• Avacados
• Deficiency
• Neural tube
defect
39. 9- Pernicious anemia (vit B12):
Macrocytic, pan cytopenia.
Occurs in pregnant, vegetarian, after gastrectomy.
Prevention: vitamin B12 supplement.
40. 10- Scurvy or vitamin C deficiency:
In bottle fed infants, pregnant, elderly,
workers in desert who consumed canned food.
Manifested by general weakness, muscle and joint pain, swelling
of gums, bleeding, blepharitis, anemia, stomatitis, gingivitis and
impaired healing of wounds. Hemorrhage under skin, and joints
provoked by slight trauma. Anemia occurs because of decreased
iron absorption.
Prevention:
increase intake of fresh vegetables and fruits (vitamin C
is heat labile, easily oxidized and destroyed by storage).
42. 11- Aribofavinosis or vitamin B2 deficiency
In vulnerable groups, in vegetarians.
Angular stomatitis, seborrhea around nose,
eyes and ears. Circumcorneal
vascularization, lacrimation.
43. Riboflavin (B2) deficiency
• Functions:
• Helps in
metabolism
of
carbohydrates
, proteins and
fats.
• Food sources:
• Whole grains,
yeast
• Organ meats (
liver and
kidney), eggs,
milk, milk
products,
• green leafy
vegetables
• Deficiency
• Angular
stomatitis.
• Cheilosis
• Tongue
inflammation
• Cataract
